AccountId: 011433970860
ContactId: c702c37c-4aee-47e7-95a2-8e33bc2bbdbe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357579 ms
Total Talk Time (AGENT): 133246 ms
Total Talk Time (CUSTOMER): 138152 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/c702c37c-4aee-47e7-95a2-8e33bc2bbdbe_20250613T17:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I need your assistance to check the claims.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] And what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 02549553
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Patient is [PII] [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the amount of the charge?
[CUSTOMER][NEUTRAL] Charge I have $80803 even.
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] And the balance after primary?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] $45 left on copay.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] [PII]. And you said the date of service was [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I do not show we received that claim. Can you verify the mailing address the claim was submitted to?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh wait, hold on, I do show that claim was received and it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Client was actually faxed that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was received and denied as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Give me one quick second, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But this is not an office visit code, right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's trying to place the services in an office, which is not covered under the policy.
[CUSTOMER][NEUTRAL] I have built this transitional care.
[CUSTOMER][NEUTRAL] That need to be inside the hospital within that.
[CUSTOMER][NEUTRAL] Do you have the copy of your view for this one?
[AGENT][NEUTRAL] A copy of the ELB that we sent.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, yes. Uh, you have that you may fax me now?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 303
[CUSTOMER][NEUTRAL] [PII]. You got it?
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes, you may keep my name in the attention box.
[AGENT][NEUTRAL] OK, is there anything else, [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] May I know the patient plan name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Gap
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I said it's called [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the received and the processed dates?
[AGENT][NEUTRAL] The claim was received on.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII], process on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] But one of your agents, uh, confirmed the [PII] there is no claim on file.
[AGENT][NEGATIVE] I just told you we received the claim and it was processed as office visits are not covered, and you asked me to send the EOB, so apparently we did receive the claim.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, and what's the process to date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, if I disagree with your denial or uh with your reason, can I go with an appeal? Should I need to build this patient?
[AGENT][NEUTRAL] Alright, you have up to 180 days to submit an appeal from the time the claim was processed, and we can't give patient responsibility. We can only verify how the claim was processed, which was not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can I have the claim number for this?
[AGENT][NEUTRAL] 359-9502.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It is actually 359-9502, right?
[AGENT][NEUTRAL] 359-9502.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Before call reference when can I expect your fax?
[AGENT][NEUTRAL] Uh, hopefully in a few moments.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today? You may use my name in today's date.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Call references.
[CUSTOMER][NEUTRAL] Call reference please mhm.
[CUSTOMER][POSITIVE] Bye bye, hope you have a good weekend.
[AGENT][POSITIVE] Mhm thank you for calling APL bye.